From diagnosis in August 2013, this is my mission to come to terms with the condition and achieve my dreams

Tag: Quantified Self

An important part of getting fitter, and improving both speed and endurance is training the body to burn fat at higher levels of intensity. This is really important for athletes who do the things I like doing – running (because they can go faster and further) and mountaineering (because mountaineers don’t have very good access to food to top up their limited carbohydrate stores).

One of the advantages of having diabetes is that I can observe how much carbohydrate I need to eat to keep my blood sugar stable. Does this mean that I have an insight into how well my body is adapting to burning fat? Can this help anyone else?

I’ve been going to the monthly quantified self meetup whenever I can. They are really interesting evenings. At each evening, three people present on any aspect of self quantifying they have been doing. Given that I have diabetes and track a lot of data these days, I feel like there’s stuff I can learn from the presentations. Even if they’re not relevant to me they are normally fascinating, and this techy geeky world is something I wouldn’t have discovered without my diagnosis (the gift of diabetes keeps on giving…!).

At the last meetup a photographer called Travis Hodges gave a presentation on his work. He is doing something called “follow me” which is where he took a photo of someone, got them to tweet one of their friends and then took a photo of them. The chain goes on. The collection was so successful that he was asked to do an exhibition in Brixton, and decided to do portraits of self trackers, their devices, their motivations and their data.

Gratuitous shot of Mont Blanc. What an amazing view to have whilst marching 850m up a hill.

I’ve just come out of a two week long cold. Despite evidence to the contrary (I got diabetes six months ago), I think of myself as someone who never gets ill. So getting a cold and feeling low on energy and not wanting to run was a real blow. Not least because my fund raising page reminds me that I only have 54 days left to the Marathon. Given that I want to run it in a very challenging time, two weeks of almost no quality training is a real blow. I’m still waiting for comments on whether I should run the marathon in a Onesie by the way. So far two people have commented, and that’s not quite enough to encourage me to do it!

This is where it all started – running in Chamonix in September made me want to do an ultra marathon in Chamonix. I found out yesterday that I have a place in the CCC – a 100km race from Courmayeur in Italy to Chamonix. It includes 7500m of vertical height difference.

Waking glucose – it was perfect for a few weeks round the start of December

I’m still in the honeymoon phase. That means my body produces a small amount of its own insulin and is therefore capable of controlling my blood sugar to some extent. In theory, if I was sensitive enough to this insulin, could my body control its sugar levels like a healthy person? Who knows!

For a few weeks before Christmas, I was consistently waking up with blood glucose readings of between 5 and 6 mmol/litre. That is basically PERFECT. It’s what a healthy person would wake up with. I started noticing that, and I also noticed that it was often 5.7 regardless of what level it was when I went to bed.

Over the past month it’s been between 6 and 7 when I wake up. That’s still good, but not PERFECT. I’ve noticed the change in trend and want to know why.

(Click on charts to enlarge.)

The blue line in the chart above shows my average waking up glucose. You can see a golden period before Christmas, where average waking up glucose was about five despite average glucose when I went to bed (red line) being higher. For the rest of the time, glucose on waking is pretty well correlated to glucose when I went to sleep. This suggests that my long acting insulin (Lantus – I take it before bed and it acts like “background” insulin, staying in my system for 24 hours or more) dose is about right.

What explains the really good waking glucose levels, and what explains them not being quite as good now? Please forgive the very busy chart below – it shows average waking and bed time glucose, how many minutes of running I did a day on average and average grams of carbs I eat before bed.

It’s not lantus

My Lantus dose has been steadily dropping as I seem to become more sensitive to insulin over time. (You can see I took it down to just four units while I was skiing, but it’s back up to 5 now.) There’s no obvious correlation between Lantus dose and waking blood sugar.

It’s not what food I eat at bedtime

If my blood sugar is a bit low when I go to bed, I normally eat something so that I don’t get a hypo. Am I eating more before bed now than I was? You can see from the chart that the opposite is actually true – I was eating slightly more before bed at the same time as my waking blood sugar was best controlled.

Could it be the running?

The other line on the chart is the number of minutes I’ve run a day, on average. In the lead up to my ultra, I was doing a lot of running (between 50 and 70 miles a week, or over 40 minutes a day on average). I wonder if doing all this running makes my body sensitive enough to insulin to enable my own insulin production to control my blood glucose to the optimal level? I’m going to ask my doctor.

The chart below shows my waking blood glucose, with periods where I’ve done over 35 minutes a day of running on average. You can see that there’s a rough correlation between waking with blood sugar of between 5 and 6 and me doing lots of running.

I’m ramping up my running training again ahead of the London Marathon. I managed ten miles yesterday, 14 today and hopefully will do eight tomorrow. I’ll continue to monitor my waking glucose (of course!) and will be interested to see whether it starts coming in between 5 and 6 again.

I feel great to be running a lot again, and if it helps control my blood sugar better then that’s a nice bonus!

If you told me last October that I’d be having a second honeymoon within a year I wouldn’t have believed you. But here I am enjoying the “honeymoon period” in type 1 diabetes. The photo above is from my first honeymoon to Patagonia. I put it in the post cos it’s more interesting to look at than all the charts!

When I first got diabetes, I thought I’d be able to do loads of clever things with my data to get good at managing it. I’ve been collecting data enthusiastically, but making sense of the mountain of data I’ve produced is difficult. Plus I spent two weeks not recording anything at the start of November because I was sulking. Sulking because my smartphone app which I use to record all my data was bought by another company and they seriously dis-improved the user experience as a result. I was shocked at the emotions I experienced when something I use and depend upon every day was changed: I was more angry and upset about that than I was about being diagnosed with diabetes in the first place! So were many other users if the number of horrendous reviews on Google Play were anything to go by. Luckily they fixed the problems, but that explains the gap in my data below.

Not a bad place for a hypo! The photo doesn’t do it justice, but we came round the corner of the hill, the clouds parted and we had a spectacular view of the Argentiere Glacier. By testing regularly during exercise, I hope to gain a better understanding of how to manage my blood sugar and minimise risk.

When I was diagnosed, one of my first questions to Dr Powrie was “can I still climb mountains and run long distances?” He told me that it would be complicated, and that I should maybe reign in my ambitions.*

I’m not going to reign in my ambitions.

Having diabetes makes doing prolonged physical activity a more risky because of the risk of experiencing a hypo (low blood sugar). It is particularly important to bear this in mind when half way up a mountain, because it is hard to get a paramedic up a cliff, and it can endanger the diabetic and his companions.

Fortunately, mountaineering is already a risky business involving lots of kit. When climbing a mountain, or descending a snowy slope on skis, one has to constantly assess risk of falling, of weather, of avalanches etc. So I already have transferrable skills I can use to manage diabetes – it’s just an additional risk factor to manage, and it requires another load of kit.

The desire to keep on doing all this stuff has given me the motivation to learn as much as I can about the condition, and part of that is to collect a load of data. I’m suffering from a bit of “computer programmers block” at the moment and can’t quite decide how best to organise the mountain of data I’m creating every day. The crux of the problem is as follows: a normal person has to eat the right food to fuel their body whilst spending a day running or climbing. I need to do that, but also take the right mix of long and short acting insulin, and the right amount of carbs to stop me from experiencing hypos.

I’ve already found, for instance that if I’m running fast (for me, I’m defining a “fast run” as any distance up to half marathon) my blood sugar generally goes up for the first 45 minutes of exercise. If I’m doing less intense exercise, my blood sugar will go down. If I’ve taken short acting insulin before exercising (for instance if I’ve gone for a walk after lunch) my blood sugar will drop fairly quickly. It’s all very complicated and whilst my intuition is improving, I think I need to analyse the data more formally as well to give me the best chance of optimal blood sugar control, and decrease the probability of bad hypos.

I’ve created some charts to help me. Here’s an example of two runs I did – one half marathon (fast) and one run over two and a half hours which involved a climb of 1200m (slow).

The chart shows how my blood sugar changed depending on exercise and carb intake. I was running during the period between the green boxes. The blue diamonds show my blood sugar at different times, and the red boxes show how many grams of carbohydrate I ate at different times. Running fast (I have defined my half marathon pace as “fast”) seems to mean that my liver releases glycogen into my blood stream at a quicker rate than I can absorb the glucose for the first 45 minutes of a run. After an hour I started eating jelly babies to prevent my blood sugar from falling too much.

This is the same kind of chart, but it was a very different run. I ran for almost two and a half hours, and climbed 1200m. It’s impossible for me to run fast doing that, and from the limited data I have (I didn’t test after half an hour which would have showed the initial response from my liver) I would say that at this slower pace my liver does not release so much glycogen into my system.

The data collection will continue, and I’m really looking forward to doing more long runs to find out about my insulin and carbohydrate requirements.

*I don’t want to make Dr Powrie sound like a killjoy. It was good of him to manage my expectations. I’m very lucky to have found such a good doctor and I have found him very supportive over the past two months.

I am of course exaggerating with the title of this blog post. I have type-1 diabetes, therefore I am insulin dependent.

However, since being diagnosed seven weeks ago, I have become much less dependent on insulin than at first. In my opinion, this is down to two things. Firstly, when newly diagnosed, diabetics often experience the “honeymoon effect”. I don’t think this is fully understood, but it seems that before treatment starts, the remaining insulin producing beta cells are working flat-out and are totally knackered. (A bit like the shortly-to-be diagnosed diabetic!) When treatment starts, these cells recover a bit and can produce more insulin which helps newly diagnosed diabetics to control their blood sugar fairly easily.